Nerve-Sparing Modified Radical Hysterectomy for Severe Endometriosis and Complex Pelvic Pathology.

Background Laparoscopic nerve-sparing modified radical hysterectomy with or without robotic assistance is known for its benefits as a definitive treatment for severe endometriosis. Undiagnosed endometriosis is common in patients with symptomatic fibroids or chronic pelvic pain. There are minimal studies that outline the safety and feasibility of nerve-sparing modified radical hysterectomy for other complex pelvic pathology in addition to endometriosis. Objectives The aim of this study is to evaluate the incidence of hospital readmission, intraoperative and postoperative complications, and long-term pain relief after laparoscopic nerve-sparing modified radical hysterectomy for severe endometriosis and complex benign pelvic pathology. Study design We performed a retrospective observational study of patients who underwent laparoscopic nerve-sparing modified radical hysterectomy with and without robotic-assistance with a high-volume minimally invasive endoscopic surgeon between November 2017 and December 2019. Results A total of 112 patients met the inclusion criteria. There were no cases of vaginal cuff dehiscence, venous thromboembolism, genitourinary system injury, gastrointestinal tract injury, vessel injury, nerve injury, sepsis, or death. Three patients required postoperative hospital admission for the management of umbilical cellulitis, acute blood loss anemia, and possible Addison's crisis. Other postoperative complications included allergic reaction to adhesives (1.8%) and urinary retention (0.9%). All patients reported significant pain relief at the time of their postoperative visits. Three patients reported return of pain symptoms within the first seven months after surgery, with one requiring an additional surgery for persistent pain. Conclusions Laparoscopic nerve-sparing modified radical hysterectomy with or without robotic assistance is a safe and feasible alternative that provides long-term symptom relief in patients undergoing hysterectomy for a variety of indications.

BCL-6 Overexpression as a Predictor for Endometriosis in Patients Undergoing In Vitro Fertilization.

OBJECTIVE: To evaluate the positive predictive value (PPV) of endometrial BCL-6 overexpression as a noninvasive screening test endometriosis in patients undergoing in vitro fertilization (IVF). METHODS: Retrospective cohort study at a university-affiliated private practice. Inclusion criteria were reproductive age females currently undergoing IVF with a diagnosis of unexplained infertility or unexplained recurrent pregnancy loss. Those with endometrial BCL-6 overexpression underwent laparoscopic surgery with an indication for treatment of suspected endometriosis. The primary outcome was the PPV of endometrial BCL-6 testing to surgically diagnose endometriosis. Statistical analysis was performed using SPSS v.25.0. RESULTS: Seventy-five patients met inclusion criteria for our study. The PPV of BCL-6 testing for endometriosis was 96%. Of those patients without endometriosis, 100% had other inflammatory pelvic pathologies, which were diagnosed and treated at the time of laparoscopy. CONCLUSIONS: Endometrial BCL-6 overexpression has a high PPV for diagnosing endometriosis and can help identify a patient population that may require surgical treatment before embryo transfer.

More chorionic villi obtained at a single center compared to previously published reports.

UNLABELLED: Abstract Objective: The chorionic villus sampling (CVS) technique is not standardized between institutions and can vary greatly between operators. Our goal was to (1) compare the amount of villi obtained by the transabdominal (TA) and transcervical (TC) CVS; (2) compare our single center yield of villi to previously published reports. METHODS: Women undergoing CVS in a singleton pregnancy between 2009 and 2011 were retrospectively identified at a single center. TA CVS was performed using a 20 gauge spinal needle. TC CVS was performed using a 1.4-mm suction catheter. Milligrams of villi and blood from all TA (n=97) and TC (n=36) CVS were obtained. STATA software was used to perform statistical analysis. RESULTS: The median amount of tissue obtained during a TC CVS [50 mg ; range (5-200 mg)] was higher than the median amount obtained from TA CVS [36 mg; range (8-140 mg)]; p=0.002. There was more blood contamination in the samples obtained using the TC approach (median=10 mg; range 5-40 mg) than in the samples from the TA approach (median=5 mg; range 0-27 mg); p<0.0001. The amount of villi obtained from our institution was significantly higher than has been previously reported [TC (p=0.0001) and TA (p<0.0001)]. CONCLUSIONS: TC CVS produced significantly more villi than the TA approach. However, both techniques generated enough villi for direct testing. This information may be useful when multiple genetic tests are being requested. Regardless of route of sampling, the volume of villi obtained was higher at our institution than previously reported. More information regarding amount of villi obtained and relationship to pregnancy complications is needed.